When people want help with a problem (like pain) they most
often want to know
How to fix it
How long it will take
My last few Instagram posts were shoulder movements that you
might have found helpful. So, if you came to me asking for help in regards to
shoulder or perhaps neck pain, would I choose to have you do them as thething for you?
Maybe. Maybe not. It
You see, the thing for you is likely not to be the thing that helped me or someone else for that matter.
Which is why looking to find the thing or the fix for chronic pain often leads to frustration. Or further
along the line, a sense of hopelessness.
There are variables between you and I not only in our
physical structure, but also other areas that affect what we might feel or
experience in any moment, on any given day. Particularly when it comes to pain.
And most often, it’s usually not just one thing.
Over the last couple of months, I offered up some movements specific to feet, hips and shoulders that you might have found useful. Whether you’re seeking greater mobility, ease, gaining more awareness or perhaps you’re trying to overcome some issues with regards to chronic or persistent pain that you experience. It can take some time to make progress, or it can actually be rather quick in learning what does, or does not provide relief for you or at least the ability to move with more ease.
I find it most hopeful to know there many things we can try along the way.
And no, it’s not just cherry-picking, or somehow blindly choosing, either. What’s been learned over the years in regards to pain is quite different from our understanding of the past in terms of causation and most important, what might be effective treatments.
It’s now understood that long-term pain is poorly correlated to tissue health and science shows us that it is both complex and often has a multitude of factors. We do feel pain IN our body. However, it is often a nervous system issue… which often increases our sensitivity to pain. We can affect our nervous system. We can affect change. We can affect our physiology. Which is what makes this a hopeful message.
For the most part, any movement you add into your day and into your life will be of benefit. What’s key while moving is for you to build awareness of what works and what doesn’t for you. What feels right and what doesn’t, for you.
If you learn to pay attention to even the most subtle of sensations, you’ll begin to notice and learn all kinds of things about your body and your self which will lead to the other things, that often play a part in your unique experience of pain.
So it’s not just one thing. Or the thing. Or your thing. Or my thing.
What are the other things, that might be contributing to your experience of pain? More to come…
Though I’ve been focusing on the feet these last few weeks, if you’re having problems with your feet you may also want to make some other connections. Yes, similar to what we’ve been exploring there are things you can do physically that will help. But our feet are connected to our leg bones, our leg bones are connected to our hip joint. Our hips are connected to our spine and further it goes, up the whole body.
We tend to look where pain expresses itself… and think we will find the solution there.
Some people may have knee problems and look to ‘fix’ the knee when really what’s happening (or not happening) is at the hips or at the feet. Or elsewhere.
Imagine you have a cast on your ankle and how it might feel when you walk. How your body might compensate. You may end up with a sore back or shoulder muscles as you try to move as best you can with a stiff, unable to bend, ankle. We’re not usually walking around with a cast on, but many people don’t really use a lot of their ankle flexion for a whole host of reasons. Shoes, patterns of movement, previous injury, etc. Pain may be expressed in your back or shoulders when what’s really going on is down at your feet.
People will often say, “yes but I had an x-ray or ultrasound and they found this (insert condition here) is wrong with my feet”. Yes, I’ve been there too. Diagnosed with chronic plantar fasciitis in both feet, osteoarthritis in both big toes. Basically, I was told to wear rocker shoes, orthotics, and live with it.
Orthotics absolutely serve a purpose in many cases but I’m not sure of any other body part we are willing to cast or brace for a lifetime. We might need a collar brace, but not forever. We may need to wear a special boot to help with a foot injury or after surgery. The point is we work hard, physiotherapists and others work hard with us, to remove these external or artificial supports. Our feet and some orthotics, in my opinion, should be no different.
After my own diagnosis and subsequently learning that our body will most often adapt to what’s asked of it, I figured there must be another way. I have put some effort and focus on my feet in many of the ways shown last month but what was happening in my hips (lack of strength and stability) also played a part.
There are often many pieces to the puzzle of long-term, persistent or chronic pain.
For instance, why was it my feet didn’t always hurt? Why only sometimes? Some days?
Paying close attention I came to notice that when under stress, under too much ‘load’, my pain was likely to arise or increase. If I was out enjoying myself, not a care in the world, doing something fun or even necessary perhaps, I didn’t seem to have pain. But at other times, it most definitely kicked in.
Adding load, good stress, to keep the bones healthy
Wearing appropriate footwear; allowing for space, mobility, flexibility
Keeping my overall ‘weight’ in a manageable range
Knowing that my levels of stress, fatigue, diet and a range of other factors may also play a part.
In the month of November, we’ll explore our HIPS (Yes, I switched my focus this month from shoulders to hips. We’ll get to shoulders in December). This is where load and/or gravitational forces are primarily distributed through the body so how well we manage this, matters.
Along the way, I’ll throw in a few morsels about chronic pain that might help you make sense of your own personal experience with persistent pain in the hips, or elsewhere.
When I used to write about yoga for a local magazine, the numbers of Americans practicing yoga was about 20 million. Today, about 6 years later, that number has nearly doubled, edging up towards to 40 million. Globally, the estimate is about 300 million and the number of over 50s practicing yoga has tripled over the last four years.
People often wonder what this thing called yoga actually is. Difficult to answer in just a sentence but to me YOGA is the exploration, awareness, and response that informs how I (might best) relate to the world inside myself and to the larger world around me.
A large part of this doesn’t involve the physical yoga postures or asana practice, but that’s usually where people begin. It is a good way into the wider exploration. Most, practice on a mat and typically in a group class. Certainly, it’s where I began.
Not knowing anything about yoga when starting out, I first practiced Ashtanga yoga and then when I began teaching it was a somewhat modified Vinyasa practice. Both involve strong, physical, almost gymnastic-like movements linked with the breath. Ashtanga, in particular, is meant to be practiced for 1.5hrs each day, 6 days of the week.
My practice today no longer resembles this in the least. Today, my physical yoga practice is interweaved throughout the day, with broader concepts in the background.
Most often it does not take place on my mat.
Most often it is less than 30 minutes at a time.
Most often it’s a response to whatever I feel might best serve me, at any given time.
No special place, clothing, or time.
Which I think might be a helpful way to practice for many who don’t have the time, money, or perhaps ability to get to a studio or gym.
What does this practice look like?
Join me over the next few months and we’ll look at little snippets of yoga, movement, breath practices that can be done in a couple of minutes or combined to make your own personal practice. On your own time, in your own space, that fits into whatever your life demands of you.
Most important to me is to teach people what they can do for themselves. Provide agency. The ability for you to have the tools and the freedom to make choices that enhance your wellbeing and your life.
In October we’ll focus on the feet.
November will be all about the shoulder joint.
In December, we’ll get into the hip joint.
I’ve chosen these particular areas to focus on as they tend to be where problems, pains, issues show up for most people I talk and work with.
After receiving basic information about the University of Ottawa Heart Institute’s Heart Wise Exercise program, presented at my yoga therapy training, I wanted to go back to learn more so paid them a visit earlier this week. Theirs is a program that helps to connect patients who have been through initial rehab programs after diagnosis, illness, surgery from heart disease, to community-based exercise programs and fitness professionals. It served primarily Ottawa but over the years has expanded in/around Ontario and a little into Quebec.
I mentioned a program in Alberta that I’d found on the internet a year or so ago. In Alberta the Prescription to Get Active Program allows you to visit your doctor, receive a ‘prescription to get active’ and then find a facility in your community offering all kinds of activities from walking, strength training, yoga, cycling, swimming, dancing, etc. The ‘prescription’ allows for free access (often a series like a 10-pass visit, free month, etc.) to get you started.
I often reference the excellent program the province of BC provides to health care providers and those living with chronic pain. The Pain BC program is one of the of the best (well, the only one of its kind I know of) in Canada in terms of information, resources and programs.
It’s too bad all these programs are rather piecemeal and for the most part unknown across Canada, rather than being coordinated. I give great credit to the people and work done to provide them. It’s just our government or overriding systems that seem to be unable to provide the coordination, or funding or whatever might be needed so everyone can access them.
Regardless, for my Canadian friends and followers, feel free to check them out!
Links above, but for easy reference click on any of these links:
I originally posted this on the Yoga and Movement Research Community Facebook group earlier in the week and then realized I should probably do so for my own readers.
Hip pain, SI joint pain, osteoarthritis of the hip, scoliosis, etc. often come up for discussion as a topic of pain and injury and there’s new research that may be helpful to others experiencing these conditions or symptoms.
“Gluteal tendinopathy, often referred to as greater trochanteric bursitis or greater trochanteric pain syndrome, has a prevalence of 10-25% and is experienced by one in four women aged over 50 years. The disorder presents as pain and tenderness over the greater trochanter and often interferes with sleep and physical function. The level of disability and quality of life is equivalent to that of severe hip osteoarthritis, and effective management strategies are required.”
I’ve just been listening to a podcast, which led me to the guest’s (Tom Goom, physiotherapist) blog post, which led me to a new (May 2018) studyhe references, which then led me to some other information about hormones.
First, I find it interesting, that gluteal tendinopathy has commonly been misdiagnosed.
“GT typically presents as pain over the greater trochanter (the bony lump felt at the side of your hip). Symptoms may spread into the outside of the thigh and knee. It is commonly misdiagnosed as hip joint pathology, ITBS, sciatica or as being referred from the lumbar spine. GT is a good example of how clinical knowledge has progressed in recent years. Initially it was thought of as inflammation of the trochanteric bursa – a fluid filled sac that sits over the trochanter. However as research developed we realised 2 rather important things. The bursa may not be the issue and there isn’t really any inflammation. Later the condition was termed Greater Trochanteric Pain Syndrome (GTPS) but further research has enabled us to be more specific with the diagnosis. Bird et al. (2001) examined MRI findings of patients with GTPS, they found that nearly all patients had evidence of Gluteus Medius Tendinopathy. Swelling of the bursa was present in just 8% of cases and did not occur in the absence of gluteal tendinopathy.
The primary pathology of Gluteal Tendinopathy is most likely an insertional tendinopathy of the Gluteus Medius and/ or Gluteus Minimus tendons and enlargement of the associated bursa.”
Second, a study published in the BMJ (May 2010) shows its both education AND exercise which results in greater improvement at both 8 and 52 weeks (as compared to corticosteroid injections or ‘wait and see’ approach) in Gluteal tendinopathy. Again, how education is an important piece of the pain puzzle. Most often people experiencing pain do better with both education and movement, according to current research.
Third, right at the end of the podcast, Tom briefly mentions how hormones may play at part. Interesting again, as this is very common presentation for women who would be experiencing menopause. As noted above, 1 in 4 women over the age of 50 (myself included 🙂 )
“The continuous modulation of female sex hormones during the menstrual cycle affects the composition of tendon collagen, because the connective tissues express receptors for both estrogen and progesterone. This leads to a clinically relevant condition in relation to physical training and musculoskeletal performance of female athletes.”
Key points for me through all this is that education is a key component so “the patient” has some control. Our current systems typically leave out self-efficacy or agency of a person and rather encourages a dependence, passivity and ‘have someone else fix it’ situation. Knowing you have some understanding and influence over your health rather than the usual doubt, uncertainty and fear can go a long way. Though this does involve engagement, commitment and doing the work.
On the topic of hormones, well let’s hope that future researchers will see the need to account for such differences rather than using only males for most health-related studies. I understand it’s difficult to do given the cyclic nature, but surely it makes a difference.
If you’re interested in this, suffer from on-going pain in your a**, or are curious about how hormones may play a part I encourage you to read further. Or, you can always comment below to discuss.
Running Physio blog post: New study is a LEAP forward. He’s written a few over the last month, you may want to check out.
BMJ (June 2018): Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial.
Continuing with the second of three papers recently published in The Lancet regarding Low Back Pain. What guidelines are already in place, what’s actually occurring in practice and suggested solutions going forward.
What’s striking to me is the
clear evidence of substantial gaps between evidence and practice, that are pervasive
A few years after delving into this, I am still scratching my head how far behind we are in our medical and clinical practice given the evidence. Yet, I’m hopeful that as more and more of this gets into the public domain, much-needed momentum will begin to close the GAP. Particularly with the crisis we find ourselves in, the growing epidemic of opioid use which is literally, killing people.
What are the treatment guideline GAPS, as outlined in the paper?
study results of clinical practice and highlights the disparity between ten guideline recommendations and the reality of current health care.
Guideline Message: Low back pain should be managed in primary care.
Practice: in high-income, low-income, and middle-income settings, people with low back pain present to emergency departments or to a medical specialist.
Guideline Message: Provide education and advice.
Practice: in high-income, low-income, and middle-income settings this aspect of care is rarely provided.
Guideline Message: Remain active and stay at work.
Practice: in high-income, low-income, and middle-income settings, many clinicians and patients advocate rest and absence from work.
Guideline message: imaging should only occur if the clinician suspects a specific condition that would require different management to non-specific low back pain.
Practice: although such specific causes of low back pain are rare, in high-income, low-income, and middle-income settings, imaging rates are high.
Guideline message: first choice of therapy should be non-pharmacological.
Practice: surveys of care show that this approach is usually not followed.
Guideline message: most guidelines advise against electrical physical modalities (eg, short-wave diathermy, traction).
Practice: worldwide these ineffective treatments are still used by the professionals who administer physical therapies.
Guideline message: due to unclear evidence of efficacy and concerns of harm, the use of opioid analgesic medicines is now discouraged.
Practice: these medicines have been overused in some, but not all, high-income countries; low-income and middle-income countries seem to have very low rates of use.
Guideline message: interventional procedures and surgery have a very limited role, if any, in the management of low back pain.
Practice: these approaches are widely used in high-income countries, little evidence on their use is available for low-income and middle-income settings.
Guideline message: exercise is recommended for chronic low back pain.
Practice: clinician treatment preferences and health-care constraints limit uptake.
Guideline message: a biopsychosocial framework should guide management of low back pain.
Practice: the psychosocial aspects of low back pain are poorly managed in high-income, low-income, and middle-income settings.
As you can see, what’s recommended is not what’s being offered to people for treatment.
Though first line care is meant to be non-pharmacological,
a study from the USA showed that only about half of people with chronic low back pain are prescribed exercise. In Australian primary care and in the emergency department setting in Canada, the most common treatment is prescribed medication.
Then, there are the rates of imaging, even though it has a limited role to play (see previous post).
39% in Norway, 54% in the USA, 56% in Italy as three examples, presenting patients to emergency rooms are given imaging.
Even worse, opioids. Though data for effects of opioids for acute low back pain are sparse,
one study showed that they were prescribed for around 60% of emergency department presentations for low back pain in the USA.
More than half the total number of people taking opioids long-term have low back pain though NO randomized controlled trial evidence is available about long-term effects. Well, we can see some of the short-term effects taking place across our countries at the moment.
In terms of surgery, which has “a limited role for low back pain”,
studies from the USA, Australia and the Netherlands show frequent use of spinal fusion.
So the waste to our healthcare system is apparent, but the bigger cost is what’s happening to the people who are provided these treatments that have shown to have little success. They seem stuck in what seems a never-ending loop of pain.
“Guidelines recommend self-management, physical and psychological therapies, and some forms of complementary medicine, and place less emphasis on pharmacological and surgical treatments, routine use of imaging and investigations is not recommended.
Little prevention research exists, with the only known effective interventions for secondary prevention being exercise, combined with education, and exercise alone.”
Where do we go from here?
“Promising solutions include focused implementation of best practice, the redesign of clinical pathways, integrated health and occupational care, changes to payment systems and legislation, and public health and prevention strategies.”
Current guidelines need to be utilized which we clearly see, they are not. There needs to be better integrated education of health-care professionals including a change to the clinical-care model. Revamping the “current models of health-care reimbursement, which reward volume rather than quality”. Integration of health-care and occupation interventions so we can get people back to work and back to their lives. Changes to compensation and disability policies. Finally, public health interventions to change public’s beliefs and behaviors.
Which brings us to the last of the 3 papers, Low back pain: a call for action, up next on the blog.
My hope is perhaps you’ll come to see for yourself there are promising directions for those disabled and suffering from low back pain.
Most of the widely promoted interventions to prevent low back pain do NOT have a firm evidence base.
A surprising statement, isn’t it? These include what you have likely been told over and over again to do, yet evidence of their success is not there. Strategies about workplace education, no-lift policies, ergonomic furniture, mattresses, back belts, lifting devices. How often have you heard about most or many of these in terms of how we might prevent low back pain?
What then, seems to work?
First, is the recommended use of a biopsychosocial model.
I suggest most of the general public has never heard of this term or model of care. I surely didn’t just a couple years ago when I was first started to dig into the overarching problem of chronic or persistent pain that affects so many people.
What is this? Well, as often defined it encompasses “a dynamic interaction among and within the biological, psychological, and social factors unique to each individual.” My emphasis on the ‘unique to each individual’, as that’s turning out to be an important piece of the complexity of pain.
Second, greater emphasis is needed on
Physical and psychological therapies
Some forms of complementary medicine,
Along with less emphasis on
Pharmacological and surgical treatments.
What’s actually being utilized in our clinics?
Surprisingly, the treatments with less emphasis and effectiveness = pharmacological and surgical treatments.
Countries such as Denmark, the USA, and the UK do have guidelines around this. They are supposed to utilize exercise and a range of other nonpharmacological therapies such as massage, acupuncture, spinal manipulation, Tai Chi, and yoga.
Clinicians are meant to provide people with
Advice and education about the nature of their pain;
Reassurance that they do NOT have a serious disease and their symptoms will improve over time;
Encouragement to stay active and continue with usual activities.
I understand even the notion of engaging in movement and exercise is difficult for people who are experiencing pain. How do you keep active when you are in pain? How much does advice, education, reassurance really help? People typically go to their health care providers and want something to ‘fix’ the problem. Not more advice. However, evidence shows this does help. And, evidence shows that the pharmaceuticals and surgeries we’ve come to rely on, don’t. In the long-term, particularly. If they worked, we wouldn’t find ourselves in this predicament. Understanding that you have a part to play, in getting better, is critical.
Movement or Exercise Therapy
Going back to the problem of trying to move, when you’re in pain. Something that people may or may not be familiar with is the term graded exposure. Basically, it means you start where you can, and gradually, over time, work to increase your overall capacity.
I tell my clients it will help to do even the smallest of movements. Use your imagination and even just visualize movement if you must, but you CAN start somewhere. Move your feet, or hands, or arms an inch, if that’s what you can do today. Just begin.
It has been shown to be useful if you can tie in your exercise or movement with something you want or need to do, rather than just some kind of exercise that is not motivational for you.
It’s not really so much WHAT you do, but that you DO something.
“Since evidence showing that one form of exercise is better than another is NOT available, guidelines recommend programmes that take individual needs, references, and capabilities into account in deciding about the type of exercise.
I use tools that yoga offers and work to help keep clients joints moving in all the many ranges of motion they might need in their life. This does not mean they need to have a life-long love or commitment to yoga.
Yet, yoga does offer an important first step of building awareness and subsequently using gentle movement, breath awareness, and tools to ‘ease into a movement’ that may have be feared in the past. People can learn to calm their nervous system, work in a safe pain-free range of motion (or not increase pain). From there we work to build stability strength and power in whatever it is they want to do … be that swimming, walking, biking, skiing, playing with kids, sitting at a desk all day. Whatever it is they want to do in their life.
It should be noted that some guidelines DO NOT recommend passive therapies, such as manipulation or mobilization (think chiropractor, massage, acupuncture). Some guidelines consider these short-term options, optional. The same goes for other passive treatments received in a physical therapists office like ultrasound, nerve stimulation, etc.
Though these passive types of therapy may help to temporarily feel better, they often have many returning again and again, becoming dependent on them for relief. Much of the current research shows the need to get a person ‘involved’ in the treatment. Get their brain and nervous system participating in movements or other practices, so passively ‘being worked on’ might not be a long-term solution.
Guidelines also recommend Cognitive Behavioral Therapy (CBT), progressive relaxation and mindfulness-based stress reduction (MBSR).
This again is where yoga can play a part in terms of relaxation. I’ll often incorporate strategies from MBSR when working with clients.
Guidelines now recommend pharmacological treatment ONLY following an inadequate response to (the above mentioned) first line non-pharmacological interventions.
Paracetamol was once the recommended first-line medicine for low back pain; however evidence of absence of effectiveness in acute low back pain and potential for harm has led to recommendations against its use.
Health professionals are guided to consider oral non-steroidal anti-inflammatory drugs (NSAIDS), taking into account risks … and if using, to prescribe the lowest effective dose for the shortest possible time.
Routine use of opioids is NOT recommended, since benefits are small and substantial risks exists…
The role of gabaergic drugs, such as pregabaline, is now being reconsidered after a 2017 trial showed it to be ineffective for radicular pain … guidelines generally suggest consideration of muscle relaxants for short-term use, although further research is recommended.
The role of interventional therapies and surgery is LIMITED and recommendations in clinical guidelines vary.
Recent guidelines DO NOT recommend spinal epidural injections or facet joint injections for low back pain… they DO NOT seem to provide long-term benefits or reduce the long-term risk of surgery and have been associated with serious adverse events.
Benefits of spinal fusion surgery … are similar to those of intensive multidisciplinary rehabilitation and only modestly greater than non-surgical management.
UK guidelines recommend that patients are not offered disc replacement or spinal fusion surgery for low back pain.
For spinal stenosis … patients tend to improve with or without surgery and therefore non-surgical management is an appropriate option for patients who wish to defer or avoid surgery.
So why the GAP between evidence and practice?
Stay tuned and we’ll look to see how this is played out and why it’s imperative that we change it.
Why should all of this matter to you? Why do you need to pay attention?
The median 1-year period prevalence globally in the adult population is around 37%, so chances are you or someone you know is affected.
And, what’s even more important, is
the way we have been treating people isn’t working.
“Low back pain (LBP) is now the number one cause of disability globally.”
There are a LOT of people who experience chronic or persistent low back pain. On a purely personal note, I would say it is the most prevalent ‘problem’ people tell me about when they turn up at my yoga classes.
“Rarely can a specific cause of low back pain be identified; thus, most low back pain is termed non-specific. Low back pain is characterized by a range of biophysical, psychological, and social dimensions that impair function, societal participation, and personal financial prosperity.”
In other words, it’s complex.
Of course, there is always a need to rule out those cases where there is specific causes.
“but, this is for less than 1% of those presenting with LBP. Known causes may include vertebral fracture, axial spondyloarthritis, malignancy, infection, or cauda equine syndrome (very rare).”
So if any of these are suspected by presenting symptoms, a clinician is well advised to do testing, imaging, etc. for what are often referred to as ‘red flags’.
If these are ruled out or if you’re not suspect for these specific causes, what then?
“Most adults will have low back pain at some point. It peaks in mid-life and is more common in women, than in men.”
“Low back pain that is accompanied by activity limitation increases with age.”
“Most episodes of low back pain are short-lasting with little or no consequence…”
“But recurrent episodes are common and low back pain is increasingly understood as a long-lasting condition with a variable course rather than episodes of unrelated occurrences.”
It’s highest in working age groups so the effect to the workforce is impacted. People unable to work, earn income, the possibility of early retirement. “In the USA, LBP accounts for more lost workdays than any other occupational musculoskeletal condition”.
Then there’s a person’s identity. Consequences such as loss of independence, ability to fulfill expected social roles can be impacted. Common themes of worry and fear are identified, along with hopelessness, the strain on families, social withdrawal, job loss, and there’s the navigating through continual healthcare encounters.
Most studies underestimate the total costs of LBP, but the economic impact is comparable to other high-cost conditions like cardiovascular disease, cancer, mental health and autoimmune diseases.
Most cases are resolved within 6 weeks, however, there are risk factors for recurring episodes. For people with other chronic conditions like asthma, headaches, diabetes. Those with poor mental health are at increased risk, etc. As one example, a study of Canada’s population with 9909 participants, found that “pain-free individuals with depression were more likely to develop LBP within 2 years than were those people without depression”.
Lifestyle factors are also at play. Smoking, obesity and low levels of physical activity are associated, although independent associations remain uncertain.
Which brings us back to it being complex. There are multiple contributors, “including psychological factors, social, biophysical, comorbidities and pain processing mechanisms.”
We can see the complexity when there is a continual increase of those affected, an increase in our health care expenditures and by the recent opioid crisis that is literally taking people’s lives.
It also seems whatever we’ve been doing in terms of treatment doesn’t seem to be working.
Why is that and what needs to be changed?
Tune in next week… where we’ll get to the second paper, “Prevention and treatment of low back pain: evidence, challenges, and promising directions.”
Note: For those interested, all references/studies can be found in the Lancet paper, here.
The bad news is you may have or know someone that is experiencing chronic or persistent back pain. The good news is, there is a way forward.
Yesterday, three important papers about back pain published in the Lancet (one of the world’s oldest and best known general medical journals) were referenced in the The Guardian, The Telegraph, the BBC News and the Daily Mail . So current evidence-based information, at last, making its way to the public domain.
In briefly reviewing the papers (published March 21, 2018), the key points for me are these:
“Low back pain is now the leading cause of disability worldwide.
“Prevention of the onset and persistence of disability associated with low back pain requires recognition that the disability is inseparable from the social and economic context of people’s lives and is entwined with personal and cultural beliefs about back pain.”
“Most low back pain is unrelated to specific identifiable spinal abnormalities,”
“Globally, gaps between evidence and practice exist, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences.”
“Recommendations include use of a biopsychosocial framework to guide management with initial nonpharmacological treatment, including education that supports self-management and resumption of normal activities and exercise,…”
Thank goodness this is getting the attention it deserves so it can help people who need it most. And that’s a LOT OF PEOPLE.
Why now, finally? I think it’s gaining traction due to spiraling health care costs along with the opioid crisis that is so prevalent.
Over the next while I’m going to break down and comment upon some of the points and principles presented in the papers, as many form the basis of my work. In the meantime, if you care to read the papers yourself they can be found here.
Lorimer Moseley, one of the world’s top researchers on pain continues to make the related point that people need an understanding of what pain is and what it isn’t, as he does with a touch of humor in his TEDx Talk in 2011. Professor Moseley is most known, however, for publishing 260+ papers on pain science and his continued work as Professor of Clinical Neurosciences and Chair of Physiotherapy at the University of South Australia.And one of many leading the charge globally in what he calls a Pain Revolution.
A huge paradigm shift is required as understandably, information about what works to treat back pain and what doesn’t is confusing. It seems counter-intuitive to ask people who are in pain to ‘just move more”. As the latest interviews I’ve listened in to with Lorimer, he states that with what we’ve learned ‘recovery is, back on the table’. There is hope. As I mentioned earlier, there is a way forward.
I talk about this all the time with family and friends … who often have a hard time believing what I describe as it is a change from what we have believed for most of our lifetime.
But, if we really truly want to get people out of this pain cycle (and I will say most any pain cycle) we need to help with the understanding of what the evidence shows and how to best work with it. This will also require huge shifts in our public policy, etc. as stated in the Lancet papers.
“These potential solutions include focused strategies to implement best practice, the redesign of clinical pathways, integrated health and occupational interventions to reduce work disability, changes in compensation and disability claims policies, and public health and prevention strategies.”
So come along for the ride if you or anyone you know is experiencing chronic or persistent low back pain (or any pain, really). With 1 in 5 experiencing chronic pain of some kind, unfortunately, you won’t have to look too far.
I’ve written about this before, here. But I think it’s important to talk about again.
People associate yoga with flexibility.
I do associate the word flexibility with yoga, but it’s in how we apply flexibility to our life.
That is, we have lots of choices available to us.
People often get stuck and then their choices become smaller, and smaller, and smaller… until they feel something a little like this; boxed in.
What I’m really looking for is this:
Do you have freedom, to do what you want in your life?
Do you have the freedom to BE you?
Skills that may aid in this might be strength. Physical strength if you want to move around in the world. Be able to go jogging, walking, cycling. Even to simply pick up and play with your kids/grandkids.
Maybe you are an office worker or writer and need to sit a lot of the day. What skills might be useful to do that?
A skill may be the ability to voice your opinions at work?
Or the skills required to get a good night’s sleep, so you have the energy for the coming day.
A useful skill may be noticing what creates tension in your body.
Try sitting in a dentist chair for any length of time and notice how you feel? A sore jaw, perhaps, makes sense. But what might your shoulders feel like? Or your leg muscles? Imagine doing this, unknowingly creating tension throughout the day, and what it might create? Pain, fatigue, stiff or sore muscles.
Yoga, is all about the noticing.
Which helps guide our life, …
out of the box, and toward spaciousness and freedom.